More on Drug-Seekers
Despite the allegations of some of our detractors, most ER docs are compassionate types who generally give patients the benefit of the doubt. We don't like to see our patients suffer, and honestly we usually don't have the time or the inclination to consistently sort out who is scamming us and who is telling the truth about their medical history, their dramatic pain performance, or their allergies to medications.It is only the most heinous offenders to whom most of us would deny treatment: those who are the most frequent of flyers, those who are abusive to the staff, those who don't bother trying to follow up for definitive care/management, or those who we actually can prove are lying to us. Suspicion of lying is not sufficient for me to deny analgesia, but once a patient has been caught in a lie and the documentation is on the chart, that individual will not likely receive narcotics from me ever again unless clear evidence of injury is present. A broken arm will suffice; another "migraine" will not.
It's rare that we can ever obtain definitive evidence of lying, however. When a patient tells me that they haven't gotten any Stadol NS in two months, and a prescription is clearly documented on the chart only two weeks ago, that is a slam dunk no-brainer. Yes, I read your old charts. See ya.
When I have time to talk to a pharmacist and learn that a patient has been doctor-shopping for Vicodin, they're out the door empty-handed. When a patient sloppily writes "ES" after the "Vicodin" on their Rx, I guess they think the pharmacist is too stupid to notice. Wrong. I'll tell the pharmacist to tear it up, and I'll make a notation in the chart. When a patient crosses out the "100 mL" and writes "16 ounces" on their cough syrup prescription, then they have given us all the proof we need to cut them off. Good luck EVER getting another narcotic from either our facility or that pharmacy, buddy. Move along.
The best scammer I've seen was a 30 year old guy who was new in town, with a pretty good kidney stone-ish writhing act, and somehow he managed to put some blood in his urine. He was requiring unusually high and frequent doses of narcotics to ease his pain, and my spidey sense was tingling from the start. Still, I medicated him repeatedly, because I'm that kind of guy. I caught him in a misstatement when he claimed that he was a newly-hired golf pro at a famous country club, and he misidentified the head golf pro there. I confronted him with his error, but he stood by his statement. I should have kicked him out then and there, but again, I gave him the benefit of the doubt.
He finally "passed" a small stone, which I sent off to pathology for analysis. His CT scan eventually was normal, and his pain was miraculously improved by that time.
When I got the pathology report in the mail the following week, it read "100% artifact." He had given me a little pebble from his backyard. Hopefully he will actually suffer from a kidney stone some day, then the karmic balance will be restored.
UPDATE: ER Nursey adds some excellent points.
Labels: artifacts, drug-seeking scumbags, ER, patients
posted by scalpel at 9:10 PM
16 Comments:
I recently caught someone on their fourth visit to our ED's with the same toothache, over about 3 months. When confronted, the long series of lame excuses didn't sound convincing to me, or them. They'll get the tooth fixed, or get some new ED's.
My best moment was finding the small very fresh laceration on the finger of a frequent visitor with kidney stones. Refused a witnessed or cath UA, made a big scene, and left, never to be seen again. That was an interesting note for the chart.
Like you, I'm very PRN with the pain medications, but occasionally the obvious abusers are asking to be called on it, and I do.
GruntDoc
One of my favorites was a patient who added a '0' to 10 vicodin despite the 1 - 24 quantity box was checked. And they used a different color pen. Then came back to the ER to ask why their prescription had been cancelled. Duh!
Well, you know, these are the most difficult patients if you ask me. They, too, eventually get ill and it is quite easy at that point to dismiss their symptoms.
It happened to a patient of mine who used to come every few day for some years complaining of chest pain. On the millionth day of his attendance the millionth ECG was taken by the triage nurse with the utmost indifference only to find out that he was having a massive MI. Scary!
Anyway, I stumbled upon your blog: very nice! Pleased to meet you (and your regular readers). My blog is a (artsy fartsy) photoblog, though. You are welcome to visit it but it is OK with me if you do not find it too interesting!
I finally fired my first patient yesterday when she went to our local ER again and lied to them (again) about pain meds. She had seen me earlier in the week (before seeing me) but had failed to mention that Dr. X had given her some Percocets. I then gave her 10 Lortab (because I was already getting bad feelings about her) and then she lies to Dr. Y about both of her previous encounters.
Evidently Dr. Y gave the patient a rip-roaring piece of her mind. :)
I am NOT a legalized drug pusher!
A few years ago I was asked to admit a frequent flyer to our ED for " Crohn's Flare". This drug seeker was well known to our GI community and had been fired by every GI MD in town. After leaving a narcotics rehab facility about 60 miles from our Hospital he showed up in our ER complaing of abd pain and " Crohn's flare". The ED MD worked him up appropriately and 3 way of the abdomen showed " ileus vs SBO" and he recieved dilaudid with no improvement in his pain ( surprise, surprise). I admitted him and told him I thought he had narcotic induced ileus and treated him with IVF, NG suction and toradol ( thank god he was not " toradol allergic"- how often are you that lucky?)IV. He bitched and moaned every day and asked for narcotics. I refused to give him narcotics. He withdrew from narcotics in the Hospital and his mother called me several times each day to tell me how bad his Crohn's disease was ( I called several of the GI MD's who had seem him in the past who assured me that diagnosis was total BS, and his inflammatory markers were stone cold normal), what a cruel doctor I was and begged for narcotics for her son, then after refusing threatened me with reporting me to the state board if I did not give him narcotics. I held my ground and told the patient and his mother they could leave AMA anytime if they did not think they were receiving adequate care. After 4-5 days his narcotic induced ileus and withdrawal symptoms resolved and I discharged him. At discharge he asked for percocet in case his " Crohn's disease" flared again. I told him I would not be prescribing narcotics for him for any condition , except maybe a radiographically confirmed long bone fracture and that none of my partners would prescribe narcotics for his abdominal pain. He left in a pissed off mood BUT most importantly he has not come back to our Hospital ED since that discharge. I figure the ER MD's owe me one. I do feel for them though as they are " damned if they do, damned if they don't" with regards to pain and these drug seekers.
We have the frequent flyers, too. One of my favorites, the first time I encountered her, told me she was allergic to fentanyl. I discovered in my assessment that she was wearing a duragesic patch... The best part (I found out later) was that she had put it on shortly before calling 911 for "abdominal pain."
Whenever we get a call to her address now (for abdominal pain, of course) and she sees me, she asks that my partner take care of her.....
BUSTED!!
Nice blog but I did want to say that not every person you people run into is a total shitbag. It has been the experience of many a good man and woman that some are allergic to Toradol and yes, some of us can have seizures on Demerol.
They told me back in '99 after breaking my back in a rock climbing incident that there was no WAY that I should be having chest pain and GI upset with Vioxx, the super touted wonder NSAID. I told them I prefered 800 mg. Ibuprofen. Certainly I HAD to be searching.
Now, anecdotally, we know better about "VIOXX" don't we? I am compassionate to the fact that you all deal with some real crapheads, but like the police or anyone else, you folks need to get out of medicine if you're that cynical. For the most part, you're dealing with a small segment of society; not the majority of people but it DOES have a piss-off factor of a 1000+ when you have an ass playing mental chess with you and you feel like shit before daylight.
I think it really pisses docs off when the newer drugs don't live up to the hype.
Just saying my peace man because if this post pisses you off, you should be me dealing one of you; and yeah, I am 41 and have had migraines since I was 15 and pancreatitis; just got out of the hospital today with an ileus (bacterial) the doc offered pain meds and I said hell no just let me have the Flagyl because they have made me resent them and I'll deal with the pain. Hell, I hope I'm never terminally ill, you guys are getting as undependable and non-comforting as the police and that is a damned shame. What the hell happened to your once honorable profession?
I found this forum after just returning from an er with my BF. He has has a few past incidents of kidney stones. Tonight He had severe, excruciating pain. I actually sat with him for an hour and a half as he was curled up and shaking in pain on the bathroom floor. He was recently laid off and we have no insurance so we tried to hold out going to the hospital but the pain just seemed to continue to intensify. Instead of getting treated we were interrogated. I was completely unprepared for how we were treated. I did become annoyed with the dr..which in retrospect i see only added to their preconceived ideas. I'll add that we are hispanic. As I was slowly connecting the dots as to why we are being treated this way I started to realize their perspective. That they must get people faking all the time. This concept and that this scenario would be a issue didn't cross my mind because all i was concentrating on was watching someone I love suffer and I could not understand why they were not being responsive to help. They said they wanted to do a ct scan and VERIFY that he indeed has a kidney stone BEFORE they would consider giving him ANYTHING. I see there perspective but I actually HOPE that they would find themselves in this type of pain. I feel traumatized by this whole ordeal. I feel like crying. I feel worried that he could have problems again and we will have no where to turn. When we get money I will have to see if I can get some documentation from a urologist so I will have proper records so this won't happen again. Now I know.
I've experienced the same thing in the ER with kidney stones, even though I have an extensive history of stones and stent surgeries.
In reading about the drug seekers that you have all caught - do you ever report them to the State? Or to wherever it is you'd report them to?
I too have been discriminated against, treated poorly, interrogated and left to suffer in the ER & now avoid it at all costs! Don't get me wrong, I'm not a frequent flyer, I've been to the ER twice in the last 12 months. Additionally, I'm not prescribed, nor do I regularly take pain meds and actually avoid them unless absolutely necessary.
My disgust with the ED has nothing to do with whether I receive narcotic pain meds - I could care less what they give me, just make my head stop feeling liking it's going to explode! My disgust has more to do with the way I've been treated, and the length of time it has taken to receive ANY treatment because on the 2 occassions I have gone to the ER my medical problem has been one that drug seekers, apparently, commonly use, migraines.
Just from those two occassions, I would rather, if my regular GP is not available, suffer at home & won't go to the ER unless the pain is unbearable (8.5 or higher on pain scale). I suffer dibilitating migraines. After giving birth naturally, I can tell you that the pain of some of my worst migraines is far worse than any pain I ever suffered while giving birth to an over 9 lbs. baby naturally.
All of you in the medical profession say not to blame the doctors but to blame the drug seekers. Don't get me wrong, I have no pity for those idiots, but I don't think the doctors are blameless in this matter either. After all, doctors are some of the most highly paid people in this country and they undergo extensive schooling & training that should make them much more perceptive to those who have true pain & those who are drug seekers. From what I see of the ED recently, the basic premise is that ALL people who come in with migraines are drug seekers, unless they can proove otherwise and they will, for hours, at your expense while you lay in pain!
During my last migraine, my husband had been begging me to go for almost 24hours. I was vomitting, couldn't sleep, couldn't eat, and my head - can't even begin to describe the pain, sensitivity - for those of you that have them, you know exactly what I'm talking about & for those that don't you could never imagine it!
I finally conceded and went to the ED. It was quiet - no ambulances coming in and one other person in the waiting room. I was triaged right away, which was promising, but no matter how much I begged, the flaky nurse wouldn't turn off the damn glaring florescents in the room! This made matters worse and I vomitted again. I was taken back to an exam room. Relatively quiet in the rooms as well. Some folks but no one looked life threatening (we live in a small town so the ED is tiny & you can pretty much see everything when you walk in). Two doctors were behind the counter and about three nurses. They were huddled up around the computer giggling and in obvious conversation. Thank goodness my husband hit the lights in the exam room & then the wait began. I had to have hubby close the exam room door because the laughter and jovial conversation of the nurses/docs had escalated & I couldn't take the noise.
Finally after about 40 minutes a doctor came in. He had 101 questions for me, none of which I could really answer because I was in so much pain it hurt to speak and I could feel every hair on my head as if it were being plucked from the root. All I could manage to get out to him in a whisper was that I couldn't talk because my head hurt too much. He examined me and, proceded to speak with my husband for information. He was very LOUD and he and my husband stood over top of my bed BELLOWING over top of me. If I'd the energy I would have ended up punching them both! For whatever reason they got on a conversation of my RLS because there are certain meds I just can't take because they aggravate my RLS terribly. (Unlike a drug seeker I can take Tylenol and non narcotic pain relievers. I mainy have problems with stimulant type meds - stuff w/caffiene in it commonly Rx'd for migraines, some of the non drowsy allergy meds - stuff like that) The doctor then, apparantely, wanting us to know just how smart he was, when into a lengthy diatribe about his studies of RLS and how restless leg syndrome is a fake illness that has been made up by the drug companies so that they could put out meds and charge lots of money for them (I lay there thinking, you should come to my house some night when I'm up pacing the floors all night long and then say that). He then went on to say that migraines were merely a product of environment and life choices and that if I ate healthier, excercised more, avoided caffiene and stres, I'd not have migraines; in other words, blaming my illness on me. Hmmm - I work out one hour a day, I'm in very good shape, I take vitamins and eat healthy - sure I have stress and indulge in some caffiene but didn't when I was 10 and I've had migraines on and off since). So now I've been told that half my problems are in my head (I'm crazy) and the other half are my own fault! Both of which are really starting to make me wonder, in my current sick - oh vomitted again in between - and painful condition whether this guy actually took the oath, to, 'do no harm' because it sure didn't sound like it!
By that point, I wanted to kill the man! If I weren't in such pain that I couldn't speak or move, I probably would have let him have it! Finally he left the room and said the nurse would be back with some meds that he commonly uses for migraines (an IV cocktail) that he thought would help. Finally, I had my husband close the door and I tried not to think about the pain, embarassement and humiliation I'd just suffered, but tears were coming to my eyes as I laid there - out of pain, anger and humiliation.
It took almost an HOUR for the nurse to return with the IV meds for me. She gave me Phenergan, IV fluid Bendadryl & Toradol. While she was hooking up my IV my husband made a polite comment that they must be busy because it had taken a while (not a complaint, he was very complimentary and pleasant). The nurse actually responded and said, "We're actually getting to you quickly because you're not a drug seeker. We make the seekers wait a lot longer!".
After doing some research on the net into how people possibly perceived as seekers are treated in ER's I now see that it probably took 40 minutes to see the doctor and then an hour for any meds because this masochistic "doctor" felt he had to research me TO DEATH to give me non narcotic pain relief and didn't have the good common sense, to examine me and tell that I was not a drug seeker. I'm sorry but given the condition I was in this doctor should have been able to make a much more expediant judgement call with regard to whether I was an addict or not. Not only was my pain obvious to anyone who saw me but he had more than enough information on me to quickly see that I was an upstanding citizen: The fact that I lived right down the street (no out of town seeker), never ONCE requested narcotic pain meds, have medical insurance (which they were given my card and had me in the system from a previous visit for my 6 year old) and he was given my COMPLETE medical history with all dates and my GP's telephone number (matter of fact he even mentioned that he knew my doc pretty well - they had done residency together!)
They also took my blood and apparantely waited to see if I had drugs in my system before giving me nonnarcotics for my pain. When my husband asked why they were taking the blood the nurses only response was, 'standard procedure'. I told them I'd not taken anything since the day before when I tried the Relpax again that my doc Rx'd but that never seemed to work for me.
This wing ding probably contacted my doctors, other ED's, pharmacies, all over the place to make sure I had not doctor or pharmacy shopped, and then checked all the medical/insurance records he could find on me. If it weren't for the fact that I'd been waiting for an hour in excrutiating pain I wouldn't care - I have nothing to hide. What infuriates me is the fact that these doctors look down their noses at any individual who presents in their ER with a migraine and discrimate against us, immediately thinking that we are drug seekers.
After the IV meds worked their way into my system my pain subsided a bit and I slept. The doctor woke me up to speak to me after about an hour had passed. He'd asked and, admittedly, my pain was down from 8.5 to 5 or 6 - still there but at least the Benedryl allowed me to sleep & the IV fluids relieved the dehydration. At that point, I was at least able to speak to him, softly but the damage had already been done so there was no point risking more pain by getting myself worked up and yelling and screaming. I asked how long the meds would last and he told me about 6 - 8 hours, enough for me to get a good night's sleep. Although I said or asked for NOTHING, I was concerned because the next day was Sunday and I wouldn't be able to see my doctor if the migraine returned until Monday and there was no way in hell I was returning to his ER, even if I were dying. Still, when he told me he'd not be sending me home with any meds because the narcotic pain relievers were too addicting, I had to shake my head and roll my eyes. Not that I'd wanted them, but as I'd suspected, I went home and slept that night and did okay until around noon the next day, when the migraine returned. I wound up making an emergency telephone call to my GP the next day (thank God he was on call and able to call in a prescription for me). The sad part of the entire issue is that this doctor made me suffer for hours, treating me as if I were a nut case, and sent me home on a weekend with no relief from a migraine he knew, would probably return the next weekend day. All of this, when the man had more than sufficient information to tell that I was NOT a drug seeker or a drug addict. Amazingly, he spent so much time making me wait in pain to confirm that I was not a seeker only to not give me any narcotic pain medications anyway and the bill to the insurance company ended up being almost $4,000 primarily for all the item I had to lay there in PAIN!
Sorry the story is so long, I just felt it needed to be told. I felt that those of us on the other side of the story - that are not doctors and not drug seekers or addicts - needed to have these doctors see another side. All these Doctors post their smug blogs and messages like they are the pain pill GODS literally telling seekers if you want narcotics from me you'de better kiss my ass royally and it makes me sick! They come right out and say they'll give seekers meds just to get rid of them or err on the side of caution and give people the pain meds rather than risking not giving them to people in true pain. I'm here to tell you from my experience, that's not the case! And, like I said, I could care less about the pain meds, BUT I do care about getting a $4,000+ bill for being told I'm crazy, it's all in my head, I'm to blame for my illness and to lay in a bed in excrutiating pain for HOURS because the medical community operates on the premise that all migraine sufferers are seekers or addicts and guilty of such until they've made you lay there in pain for hours and proven otherwise, only to NOT prescribe you the meds anyway. Is it me or is there something just so wrong with this picture?
in my ER we believe that WE are not the docs for patients with chronic medical problems, especially those that require narcotics. We tell the patients they need to have a letter from their private physician as to what treatment HE/SHE wants. Continuity of care is important and we want to provide that. The primary care physician is in the best position for that. If our patients don't have a primary care or clinic available we offer them an appropriate referal. They get the pain meds once and in the future they have to bring a note. That works pretty good-and we keep a list of people we have dealt with in this manner.
I have had continual abdominal pain since August. I did not request pain medication until November, when a NEIGHBOR told me the obvious effects of the pain were causing too much stress for my family (prolonged activity would make me shake, turn pale, sweat and get increasingly nauseous). I then asked my family doctor for pain medication and he gave me vicodin, which did NOT do enough to stop the pain (barely touched it). We then went to hydrocodone 10/apap 325, which reduced the pain with breathrough at two and a half to three hours. Since I was embarrassed to possibly be considered a "drug-seeker" or "addict," I decided that some pain relief was better than continuing to ask for increasing pain medication, and told the doc that was good enough.
We are still working on diagnosis (have ruled out bowel conditions and are now on the second gynecologist because the first one was a masochist who offered me a laproscopy with no anesthetic in her office since I am uninsured) and either I have developed tolerance or the pain which was already barely controlled has increased past the management of the medication I am taking. Once again prolonged activity makes me very ill, and my family is frantic to see me get so ill.
I have yet to insist on changing pain medication, for fear that I will be labeled an addict, and even have considered just quitting taking what I am on in hopes that after withdrawal symptoms it will be a little more effective again once my system resets. I have no desire to be considered some "lowlife drug-seeker" or any other type of person like that... so I just endure and hope that I get a diagnosis that will allow them to medicate me enough to make me healthy again.
It seems like there are many stories that are much the same. Sure there are those who are drug seeking, but there are many who aren’t. I just hope that the doctors don’t forget what it must be like for those who have some problem and they (doctors) haven’t found it yet. Some of you are so young and don’t have a clue as what it must be like to live with something and be told it is in your head, or you're drug seeking. I was 12 when I started having problems with my ‘stomach’. I lived with it for 14 years before they diagnosed it. It was gallbladder disease and by the time I was 18, I was labeled drug seeking. I gave up asking for help and hoped when an attack happened I wouldn’t wake up in the morning. I didn’t bother to tell anyone anymore. I also developed migraines at age 16 and was receiving treatment for them; albeit not good treatment. They started to withhold treatment for them also. Today I have to take a combination of Topamax and a beta blocker to control them.
I eventually gained enough confidence to get the help of a doctor who believed something was going on. He found the gallbladder problem and helped me with my migraines… only to retire soon after.
When someone is young and a doctor tells you things like it is in you head, and you are drug seeking, it can be mind altering. I’m a teacher, and I know what I say to my students has some of the greatest impact on what they do and think in the future. It doesn’t mean that with my colleagues we don’t discuss students – and yes, some make us crazy – but we can’t tell them that. We can however tell them they are failing, not working up to expectations… as you may do so when you know for sure they are drug seeking. BUT if you are making a judgment based on seeing them once it is not necessarily a fair assessment. You (doctors) need to be mindful of what you say and how you say things to your patients – even if they are only visiting the ER once. When I was 12, and some ER doctor told me that I was fine because he didn’t see anything on his tests that could cause me that much pain, I was devastated for I was still in pain and no one would help me. It has been many years since then, and I still have a problem with trusting doctors. Some things you don’t ever forget. I’ve been living with gastroparesis for just over two years now. I avoid care and don’t feel that I would go to the ER for anything willingly.
I went to a walk-in clinic with severe otitis media. The pain was like having a screwdriver left inside my ear, forgotten about, then suddenly bumped.
The attending physician wouldn't give me any medication but instead stared me in the eyes and told me to look on the bright side.
Eventually I was given a prescription for T3's, but I could have kicked that man.
(I was soon after diagnosed as having a subtotal perforation in my left ear as a result of a fungal infection I had contracted from an apartment swimming pool. I had to undergo tympanic membrane replacement.)
I was lucky enough to have a doctor in an ER label me drug seeking after going in for severe leg pains. This was in august. I was so outdone I waited until Jan.17, 2011 to go to a different ER. This after months of taking care of my wheel chair bound mother who died on the 12, of Jan. Guess what? I have 3 compression fractures with nerves all mashed in them. This could have been eased had the first ER actually done a xray. I told the second hospital about how I had been treated at the first ER and he noted it. When I went to gather my medical records (because I found a family doctor who said he would review my records to see if he'd take me on as a chronic pain patient)..I found I was right, she put in there even though I had NO narcotics in my system that I was "drug seeking" and going through "withdrawls" UMMM.... NO MY BACK WAS BROKE.. So now I have no chance of this family doctor taking me on, with her lovely drug seeking notes.
So because she didn't even do an exam, I was label "drug seeking"
I can't go to a chiropractor and have them decompressed because they are calcified over. I can't afford a spine specialist but I could have afforded the chiropractor. So I am screwed there.
I can't afford pain management clinic at 500 dollars a shot.
I NOW can't see a family doctor for the pain because I have been labeled.
Where are my rights? I have none. I am at a loss. I qualify for no help. She never thought to think, "hey something might actually be wrong here". I can't thank Carteret General Hospital enough in NC for their time in helping to resolve the root of the mysterious pain and symptoms. But Onslow Memorial in NC, has prolonged my diagnosis, gave me a sense of shame and prolonged agony over the way they made me feel, they discouraged me from seeking more medical help. This in turn has now turned something that could have been treated and fixed to something I have to band aid the rest of my life with pain meds. They have false labeled me which now again hinders me getting any kind of real help. Thanks bunches to all the ER docs who actually listen, and those who are too quick to judge, need a new profession.
Anyone have any ideas?
NCBeth
Listen (all of you posters with >1 paragraph):
Let's assume you're all legit; for each one of you we deal with hundreds of drug seekers looking for narcs (in the ER and in outpatient settings). Your best bet is to establish with one PCP and stick with them.
You have to know by now that most states have prescription monitoring programs. I can run a real-time report before walking into your room, and I know exactly what you're getting and where and when you got it. Makes it so much easier to sift through the BS that pours out of peoples' mouths.
Post a Comment
<< Home